Direct-Acting Antiviral Therapy for HCV Infection Is Associated With a Reduced Risk of Cardiovascular Disease Events
Direct-Acting Antiviral Therapy for HCV Infection Is Associated With a Reduced Risk of Cardiovascular Disease Events
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DOI：
10.1053/j.gastro.2018.11.022
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发表时间：
2019-03-01
期刊：
影响因子：
29.4
通讯作者：
Freiberg, Matthew S.
中科院分区：
文献类型：
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作者：
Butt, Adeel A.;Yan, Peng;Freiberg, Matthew S.
背景与目的：丙型肝炎病毒（HCV）感染与心血管疾病（CVD）事件的风险增加有关。目前尚不清楚直接作用抗病毒（DAA）药物治疗是否会影响CVD的风险。方法：我们检索了HCV感染退伍军人电子检索队列数据库中的慢性HCV感染患者（n = 242，680），并确定了接受聚乙二醇干扰素和利巴韦林方案（n = 4436）或含DAA方案（n = 12，667）治疗的患者。治疗患者的年龄、种族、性别和基线值与从未接受过HCV感染治疗的患者（对照组）相匹配。所有受试者在基线时均未发生任何诊断为HCV感染的CVD事件。主要结果是在不同的组和对治疗有或无持续病毒学应答的患者中，根据国际疾病分类第九版、临床修改或国际疾病分类第十版代码确定的CVD事件。结果：治疗组发生1239例（7.2%）CVD事件，对照组发生2361例（13.8%）事件。对照组的发生率为30.9/1000患者-年（95% CI 29.6-32.1），治疗组为20.3/1000患者-年（95% CI 19.2-21.5）（P < .0001）。与未治疗（对照组）相比，使用聚乙二醇干扰素和利巴韦林（风险比0.78; 95%CI 0.71-0.85）或DAA方案（风险比0.57; 95%CI 0.51-0.65）治疗与CVD事件风险显著降低相关。聚乙二醇干扰素和利巴韦林治疗组的CVD事件发生率为23.5/1000患者-年（95%CI 21.8-25.3），DAA治疗组为16.3/1000患者-年（95%CI 14.7-18.0），对照组为30.4/1000患者-年（95%CI 29.2-31.7）。持续的病毒学应答与较低的CVD事件发生风险相关（风险比0.87; 95%CI 0.77-0.98）。结论：在一项对HCV感染的退伍军人队列的分析中，HCV感染的治疗与CVD事件风险的显著降低相关。接受DAA方案治疗的患者和获得持续病毒学应答的患者发生CVD事件的风险最低。
BACKGROUND & AIMS: Infection with hepatitis virus C (HCV) is associated with an increased risk of cardiovascular disease (CVD) events. It is not clear whether treatment with direct-acting antiviral (DAA) agents affects risk of CVD. METHODS: We searched the Electronically Retrieved Cohort of HCV-Infected Veterans database for patients with chronic HCV infection (n = 242,680) and identified patients who had been treated with a pegylated interferon and ribavirin regimen (n = 4436) or a DAA-containing regimen (n = 12,667). Treated patients were matched for age, race, sex, and baseline values with patients who had never received treatment for HCV infection (controls). All subjects were free of any CVD event diagnosis of HCV infection at baseline. The primary outcome was incident CVD events, identified by International Classification of Diseases, Ninth Edition, Clinical Modification or International Classification of Diseases, Tenth Edition code, in the different groups and in patients with vs without a sustained virologic response to therapy. RESULTS: There were 1239 (7.2%) incident CVD events in the treated groups and 2361 (13.8%) events in the control group. Incidence rates were 30.9 per 1000 patient-years (95% CI 29.6-32.1) in the control group and 20.3 per 1000 patient-years (95% CI 19.2-21.5) in the treated groups (P < .0001). Treatment with pegylated interferon and ribavirin (hazard ratio 0.78; 95% CI 0.71-0.85) or a DAA regimen (hazard ratio 0.57; 95% CI 0.51-0.65) was associated with a significantly lower risk of a CVD event compared with no treatment (controls). Incidence rates for CVD events were 23.5 per 1000 patient-years (95% CI 21.8-25.3) in the group treated with the pegylated interferon and ribavirin regimen, 16.3 per 1000 patient-years (95% CI 14.7-18.0) in the group treated with a DAA regimen, and 30.4 (95% CI 29.2-31.7) in the control group. A sustained virologic response was associated with a lower risk of incident CVD events (hazard ratio 0.87; 95% CI 0.77-0.98). CONCLUSIONS: In an analysis of a cohort of HCV-infected veterans, treatment of HCV infection was associated with a significant decrease in risk of CVD events. Patients treated with a DAA regimen and patients who achieved sustained virologic responses had the lowest risk for CVD events.